Eliciting and prioritising determinants of improved care in multimorbidity: A modified online Delphi study

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Abstract

Background

Multimorbidity is a major challenge to health and social care systems around the world. There is limited research exploring the wider contextual determinants that are important to improving care for this cohort. In this study, we aimed to elicit and prioritise determinants of improved care in people with multiple conditions.

Methods

A three-round online Delphi study was conducted in England with health and social care professionals, data scientists, researchers, people living with multimorbidity and their carers.

Results

Our findings suggest a care system which is still predominantly single condition focused. ‘Person-centred and holistic care’ and ‘coordinated and joined up care’, were highly rated determinants in relation to improved care for multimorbidity. We further identified a range of non-medical determinants that are important to providing holistic care for this cohort.

Conclusions

Further progress towards a holistic and patient-centred model is needed to ensure that care more effectively addresses the complex range of medical and non-medical needs of people living with multimorbidity. This requires a move from a single condition focused biomedical model to a person-based biopsychosocial approach, which has yet to be achieved.

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Most cited references 36

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Epidemiology of multimorbidity and implications for health care, research, and medical education: a cross-sectional study.

Karen Barnett, Stewart W Mercer, Michael Norbury … (2012)

Long-term disorders are the main challenge facing health-care systems worldwide, but health systems are largely configured for individual diseases rather than multimorbidity. We examined the distribution of multimorbidity, and of comorbidity of physical and mental health disorders, in relation to age and socioeconomic deprivation. In a cross-sectional study we extracted data on 40 morbidities from a database of 1,751,841 people registered with 314 medical practices in Scotland as of March, 2007. We analysed the data according to the number of morbidities, disorder type (physical or mental), sex, age, and socioeconomic status. We defined multimorbidity as the presence of two or more disorders. 42·2% (95% CI 42·1-42·3) of all patients had one or more morbidities, and 23·2% (23·08-23·21) were multimorbid. Although the prevalence of multimorbidity increased substantially with age and was present in most people aged 65 years and older, the absolute number of people with multimorbidity was higher in those younger than 65 years (210,500 vs 194,996). Onset of multimorbidity occurred 10-15 years earlier in people living in the most deprived areas compared with the most affluent, with socioeconomic deprivation particularly associated with multimorbidity that included mental health disorders (prevalence of both physical and mental health disorder 11·0%, 95% CI 10·9-11·2% in most deprived area vs 5·9%, 5·8%-6·0% in least deprived). The presence of a mental health disorder increased as the number of physical morbidities increased (adjusted odds ratio 6·74, 95% CI 6·59-6·90 for five or more disorders vs 1·95, 1·93-1·98 for one disorder), and was much greater in more deprived than in less deprived people (2·28, 2·21-2·32 vs 1·08, 1·05-1·11). Our findings challenge the single-disease framework by which most health care, medical research, and medical education is configured. A complementary strategy is needed, supporting generalist clinicians to provide personalised, comprehensive continuity of care, especially in socioeconomically deprived areas. Scottish Government Chief Scientist Office. Copyright © 2012 Elsevier Ltd. All rights reserved.

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The Delphi method as a research tool: an example, design considerations and applications

Chitu Okoli, Suzanne Pawlowski (2004)

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Guidance on Conducting and REporting DElphi Studies (CREDES) in palliative care: Recommendations based on a methodological systematic review.

Lukas Radbruch, Saskia Jünger, Sheila Payne … (2017)

The Delphi technique is widely used for the development of guidance in palliative care, having impact on decisions with relevance for patient care.

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Author and article information

Journal

Journal ID (nlm-ta): J Multimorb Comorb

Journal ID (iso-abbrev): J Multimorb Comorb

Journal ID (hwp): spcob

Journal ID (publisher-id): COB

Title: Journal of Multimorbidity and Comorbidity

Publisher: SAGE Publications (Sage UK: London, England )

ISSN (Electronic): 2633-5565

Publication date (Electronic): 5 September 2023

Publication date Collection: Jan-Dec 2023

Volume: 13

Electronic Location Identifier: 26335565231194552

Affiliations

[1 ]Primary Care Research Centre, Ringgold 12211, universityUniversity of Southampton; , Southampton, UK

[2 ]Wolfson Institute of Population Health, Ringgold 105714, universityQueen Mary University of London; , London, UK

[3 ]Institute of Epidemiology and Health Care, Ringgold 4919, universityUniversity College London (UCL); , London, UK

[4 ]MRC/CSO Social and Public Health Sciences Unit, Ringgold 3526, universityUniversity of Glasgow; , Glasgow, UK

[5 ]Division of Population Health, Health Services Research and Primary Care, Ringgold 5292, universityUniversity of Manchester; , Manchester, UK

[6 ]Personal Social Services Research Unit, Ringgold 2240, universityUniversity of Kent; , Canterbury, UK

[7 ]School of Psychology, Ringgold 12211, universityUniversity of Southampton; , Southampton, UK

[8 ]Digital Health and Biomedical Engineering, School of Electronics and Computer Science, Ringgold 7423, universityUniversity of Southampton; , Southampton, UK

[9 ]Nuffield Department of Primary Care Health Sciences, Ringgold 6396, universityUniversity of Oxford; , Oxford, UK

Author notes

[*]Glenn Simpson, Primary Care Research Centre, The University of Southampton, Aldermoor Close, Southampton SO16 5ST, UK. Email: G.W.Simpson@ 123456soton.ac.uk

Author information

Glenn Simpson https://orcid.org/0000-0002-1753-942X

Article

Publisher ID: 10.1177_26335565231194552

DOI: 10.1177/26335565231194552

PMC ID: 10483969

PubMed ID: 37692105

SO-VID: f094b5d2-b335-4b9b-8b8a-8970d412e7f3

License:

This article is distributed under the terms of the Creative Commons Attribution 4.0 License ( https://creativecommons.org/licenses/by/4.0/) which permits any use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages ( https://us.sagepub.com/en-us/nam/open-access-at-sage).

History

Funding

Funded by: National Institute for Health Research;

Award ID: NIHR202637

Custom metadata

typesetter ts10

cover-date January-December 2023

Keywords: multimorbidity,delphi study,integrated care,personalised care

Data availability:

Keywords: multimorbidity, delphi study, integrated care, personalised care

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Eliciting and prioritising determinants of improved care in multimorbidity: A modified online Delphi study

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Abstract

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Most cited references 36

Epidemiology of multimorbidity and implications for health care, research, and medical education: a cross-sectional study.

The Delphi method as a research tool: an example, design considerations and applications

Guidance on Conducting and REporting DElphi Studies (CREDES) in palliative care: Recommendations based on a methodological systematic review.

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